Provider Demographics
NPI:1053695262
Name:CASCADE PARK CARE CENTER/LIFE CARE CENTERS OF AMERICA
Entity type:Organization
Organization Name:CASCADE PARK CARE CENTER/LIFE CARE CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CAPS
Authorized Official - Phone:360-989-8802
Mailing Address - Street 1:808 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4699
Mailing Address - Country:US
Mailing Address - Phone:360-989-8802
Mailing Address - Fax:
Practice Address - Street 1:801 SE PARK CREST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1300
Practice Address - Country:US
Practice Address - Phone:360-260-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility